Provider Demographics
NPI:1629634621
Name:WILM, JORDAN FLORENCIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:FLORENCIA
Last Name:WILM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:FLORENCIA
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10721 CHAPMAN HWY STE 22
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4767
Mailing Address - Country:US
Mailing Address - Phone:865-579-2293
Mailing Address - Fax:865-579-2295
Practice Address - Street 1:10721 CHAPMAN HWY STE 22
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4767
Practice Address - Country:US
Practice Address - Phone:865-579-2293
Practice Address - Fax:865-579-2295
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist